The diagnostic approach to hematuria - Veterinary Medicine
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The diagnostic approach to hematuria
A common finding in dogs and cats, hematuria causes a swarm of differential diagnoses to come to mind. This internist provides a series of algorithms to help you zero in on the cause.


Examine the urogenital area and observe voiding

During the physical examination, be sure to inspect the genitalia and urethral orifice as well as to abdominally palpate the bladder, kidneys, and prostate. Although sometimes involved in disorders resulting in hematuria, the uterus is generally not palpable in intact female dogs unless it is enlarged or associated with a mass. If the bladder is markedly distended with urine when palpated, palpate it again after the animal has voided to increase the chances of palpating abnormalities in the bladder wall or lumen. Extrude the penis from the prepuce for inspection in male patients, and include digital palpation of the perineal urethra as part of the urogenital examination. Vaginal examination can be enhanced by using a speculum or digital palpation. Rectal palpation allows the opportunity to palpate the prostate in male dogs, the pelvic urethra in most patients, and the posterior aspect of the bladder in some patients. Identifying pain or irregularities during palpation may indicate that organ or structure as a source of hematuria.

Figure 4
Observe the patient during voiding to help verify hematuria and to confirm or detect abnormalities such as dysuria that could localize the source of hematuria. The stage of micturition at which blood appears can also help you localize the origin of hematuria. However, only general guidelines can be given since the stage of micturition when blood is observed often varies for any one source of hematuria. Blood seen at the beginning of urination or dripping independent of urination suggests a genital or urethral source. Blood produced at the end of urination often indicates a urinary bladder origin. Blood that persists throughout micturition is more suggestive of a kidney or ureteral origin, although a bladder origin cannot be ruled out. Urethral catheterization may be indicated in some cases, especially to assess patency in dogs or cats in which dysuria has been observed or reported.


After localizing the source of hematuria based on historical and physical examination findings, follow the most appropriate algorithm (Figures 3-7) to devise a diagnostic plan to identify the specific cause of hematuria.

CBC and serum chemistry profile

Figure 5
Performing a CBC and a serum chemistry profile is never inappropriate in patients with hematuria. However, these tests are particularly indicated in patients with systemic signs of illness; palpable abnormalities in one or both kidneys, the uterus, or the prostate; or evidence of concurrent disease. Pay particular attention to the platelet count or platelet estimate, the RBC count, and the blood urea nitrogen and creatinine concentrations. A markedly low platelet count may indicate a coagulopathy. Anemia may indicate a more severe or persistent cause of hematuria and may affect therapy. Azotemia may implicate the kidney as a source of hematuria and complicate diagnosis and treatment, especially if anesthesia or other procedures that could compromise kidney function are required.


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